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Treatment of Eating Disorders

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The treatment of Eating Disorders requires multidisciplinary collaboration and may be carried out at different healthcare levels and healthcare resources.

Outpatient clinic (or ambulatory treatment). In the majority of cases this is the “entry point” for treatment. The frequency of the visits depends on the seriousness and progression of the disorder, which may be weekly. The therapeutic program tries to achieve the objectives by means of individual sessions with the therapist responsible (psychologist or psychiatrist), family oriented sessions, cognitive‑behavioural therapy groups, and groups for parents.

Day Hospital. It is the second link in the treatment (in the cases coming from Outpatient Clinics), although it is also the “entry point” for hospital treatment. Apart from having three meals during the time in the Day Hospital (lunch, afternoon tea, and dinner), the psychological treatment is more intensive at this level. Specific cognitive-behavioural therapy groups are formed in order to work on self-esteem, body image, social skills, control of emotions, and motivation, as well as other psycho-educational groups. The individual sessions are also maintained with the reference therapy.

Hospitalisation Area. Hospital admission only occurs when the Outpatient or Day Hospital treatment does not produce satisfactory results, or also for medical reasons, such as the level of malnutrition, associated medical complications, the manifest rejection to being fed or other serious behaviour changes. Hospital admission is also assessed in the event of having depressive symptoms with the risk of self-injury. Whenever possible, treatment is always started at outpatient level (except where the clinical situation of the patient advises otherwise, and treatment in the Day Hospital or hospital admission is resorted to, when the progress is unsatisfactory). A nutritional recovery plan is followed throughout the treatment. This plan has particular and specific nutritional objectives for each patient according to personal needs.

General aims of the treatment program:

To bring the weight back to normal and restore a minimal nutritional state compatible with the physical and mental health.
To treat the physical complications arising from the malnutrition.
To correct any inappropriate eating behaviour.
To reduce and, where possible, suppress the thoughts associated with the ED, such as the fear of increasing the necessary weight and of foods.
To correct the alterations of body image.
To return family relationships to normal and resolve the conflicts directly or indirectly associated with the disorder.
To treat the altered mood changes and other associated disorders.
To improve self-esteem and the social adaptation in general.
To resolve or to advise on any other personal or psychosocial problem.

Specific objectives of the psychological treatment:

To encourage awareness of the illness and the motivation for the treatment.
To reduce/eliminate the anxiety due to the weight gain and food.
To return consumption and eating habits back to normal.
To reduce/eliminate compulsive physical activity.
To change irrational beliefs, cognitive distortions, and automatic negative thoughts in relation to food, weight, etc.
To reduce the alterations of body image.
To improve self‑esteem.
To improve social skills and relationships.
To eliminate compensatory/purgative behaviours.
To eliminate other pathological conducts, such as self-destructive behaviours, suicide ideation, etc.
To approach other personal and/or associated psychopathological problems.
To prevent relapses.

Specific aims of intervention with the family:

To offer information about the illness.
To provide the eating rules and help to implement them.
To reduce the disruption and/or erosion that the illness produces in the family dynamics.
To favour family support.
To encourage consistency between the posture of the parents and that of the therapist.
To give emotional support to the parents at the different times of the therapeutic process.
To remove the blame from the parents.

Pharmacological Treatment

The use of medication in the EDs is not recommended as an only or first-line treatment, but has to be given in the context of an integrated treatment.

Anorexia Nervosa. Nutritional recovery is a priority in Anorexia Nervosa, and medications are not indicated as a first treatment option. Medication in Anorexia Nervosa can be useful to treat the different symptoms that appear along with the ED, such as depressive symptoms, anxiety symptoms, or obsessive symptoms, among others. Medication can also be useful in some cases in which there are symptoms that make treatment or recovery difficult (increase in physical activity, episodes of aggressiveness, etc.). Among the medications most used in Anorexia Nervosa is Fluoxetine (anti‑depressant), but other medications are also used.

Bulimia Nervosa and Binge Disorder. The medication used in Bulimia Nervosa and Binge Disorder seems to have a clearer indication than in Anorexia Nervosa, but it is always combined with an integrated treatment. The use of fluoxetine (anti‑depressant) in Bulimia Nervosa is indicated combined with psychological treatment (cognitive‑behavioural therapy). Fluoxetine at high doses appears to reduce the frequency of the binges and vomiting, and improves the depressive and anxiety symptoms in these patients. There are also other medications that have demonstrated their effectiveness in the treatment of Bulimia Nervosa, such as topiramate. As regards Binge Disorders, it appears that the anti‑depressants and lysdexamphetamine are useful in the reduction of binges, and also combined with a psychological and nutritional treatment.

Avoidant/Restrictive Food Intake Disorder. On being such a recently diagnosed disorder, there are no clinical trials on the efficacy of the medication. Medication may be useful to treat the presence of other symptoms like anxiety or depression.